Active NPI
Bruce Wilson Rogers, R.PH.
- Durable Medical Equipment & Medical Supplies
- Victoria, TX
National Provider Identifier
1578604104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Practice address
- 4404 N Laurent St
Victoria, TX 77901-2742 - Phone
- (361) 576-6599
- Fax
- (361) 894-6431
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | TX | Primary | |
| Pharmacist | 183500000X | 21067 | TX |
Addresses
Primary practice location
4404 N Laurent St
Victoria, TX 77901-2742
Mailing address
4404 N Laurent St
Victoria, TX 77901-2742
Phone (361) 576-6599
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21067 | Other | TX | STATE BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21067 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698624000000",
"number": "1578604104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4404 N LAURENT ST",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779012742",
"telephone_number": "361-576-6599",
"fax_number": "361-894-6431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4404 N LAURENT ST",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779012742",
"telephone_number": "361-576-6599",
"fax_number": "361-894-6431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGERS",
"first_name": "BRUCE",
"middle_name": "WILSON",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2023-10-30",
"certification_date": "2023-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "TX",
"license": null,
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "21067",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE BOARD OF PHARMACY",
"identifier": "21067",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victoria, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.